"Pathological gambling falls into a family of impulse control disorders, similar to kleptomania," says Dr. Eric Geffner, a psychologist and nationally certified problem gambling counselor based in Los Angeles. "It's like not having brakes on a car-the car may be an outstanding car with a very good engine-that's why you get people who are very intelligent who have this disorder and are very successful. It might appeal to them as a way to stimulate their brain, maybe they're bored or can't unwind, and they need the mental stimulation of juggling scores from baseball teams or poker-it's like figuring out puzzles."
"It's not a moral disorder or a religious spiritual disorder," emphasizes Dr. Geffner. "It's a mental disorder that has neurological substrates to it. Although it's often looked upon as weakness by both the gambler and the people that are hurt by the addiction, in many cases there is something going on neurologically."
"It's a hidden addiction," says Al Gesregan, a compulsive gambling counselor in Bound Brook, New Jersey. "People don't come home smelling of alcohol or their pupils dilated as with drug addiction-they can hide it for years and years. Normally they don't get into treatment until they've lost practically everything."
But what about wealthy individuals who can afford to lose hundreds of thousands of dollars to casino gambling? Do they have a problem? "The issue of people who are extraordinarily affluent makes it more difficult to tease out," notes Dr. Geffner, who wished to clarify that he was not speaking about Bill Bennett, of whom he has no firsthand knowledge. "If an athlete is losing a million a year but makes $10 million, is it a problem? In such a case, it's important to look at whether there is impairment in their life, lack of attachment to children. Is it distracting them in an unhealthy way, is this in place of being more intimate with their family?" (For a diagnostic checklist of symptoms of pathological gambling, see Dr. Geffner's website.)
Modes of Treatment
Dr. Geffner says his approach to treating compulsive gambling includes five components: